Moderate head injury: A report on a prospective study

Abstract

Seventy five per cent of the patients sustained multisystem trauma, generally of minor or moderate grade according to the Abbreviated Injury Scale (AIS). However, the death rate increased with the severity of the injury as measured by the Injury Severity Score (ISS). The initial CT scan was abnormal in 61% of patients and no patient with a normal scan developed a delayed intracranial haematoma (ICH) or neurological worsening. Those patients who developed a delayed ICH had a worse outcome. Sixteen patients underwent craniotomy for haematoma. The intracranial pressure (ICP) was measured selectively in 20 patients and exceeded 20mmHg in half, requiring treatment. Nine patients died as a result of head injury and all those had an intracranial haematoma. As a group those who died were older and had a higher ISS. Sixty per cent of patients had a hospital stay exceeding 7 days, over half (58%) had their head injury as the primary reason for their ongoing admission. Twenty patients required a period of ventilation in the ICU. Most patients achieved a good outcome (Glasgow Outcome Score). Twenty two per cent had some form of ongoing disability. Eighty patients underwent formal post traumatic amnesia (PTA) testing using the Westmead PTA scale. Seventy eight per cent of those patients had a period of PTA in excess of 24 hours and 51% of those patients in excess of 1 week, implying the likelihood of residual neuropsychological disability.